Beyond statistics: health inequities in rural and remote communities of Australia
Authors: Subash Thapa, Kedir Y Ahmed, Allen G Ross
Journal: The Lancet Public Health (2023)

The GBD 2019 Australia Collaborators, in their analyses of Global Burden of Diseases data from 1990 to 2019, noted a downward trend in age-standardised death rates for non-communicable diseases and a general increase of 6 years in life expectancy in Australia.1GBD 2019 Australia CollaboratorsThe burden and trend of diseases and their risk factors in Australia, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Public Health. 2023; 8: e585-e599Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar We believe that the national data presented does not fully capture the burden of disease in rural and First Nation communities. About 7 million (28%) people and 260 000 (32%) First Nations Peoples reside in rural and remote areas in Australia. There are over 1700 small towns with populations smaller than 10 000 people. For each community, effectively collecting and analysing population data presents a sampling and statistical challenge. The national averages create only proxies for local communities that might not be reflective of the health gaps. Although the life-expectancy gap is approximately 8 years between First Nations Peoples and non–Indigenous Peoples at the national level, this is as high as 13 years in rural areas of the Northern Territory.2Zhao Y Li SQ Wilson T Burgess CP Improved life expectancy for Indigenous and non-Indigenous people in the Northern Territory, 1999–2018: overall and by underlying cause of death.Med J Aust. 2022; 217: 30-35Crossref Scopus (7) Google Scholar Furthermore, the median age at death differed between First Nations and non-Indigenous communities by at least 20 years, with the rates varying substantially among rural areas (figure).3Public Health Information Development UnitTorrens University AustraliaSocial Health Atlas of Australia: Population Health Areas.https://data.sa.gov.au/data/dataset/social-health-atlas-of-australia-population-health-areaDate: 2018Date accessed: August 15, 2023Google Scholar The important difference in disease burden between metropolitan and rural areas is not solely based on socioeconomic differences. There continues to be a substantial disparity in health-care access and the availability of a skilled workforce for the prevention, early diagnosis, and improved case management of non-communicable disease.4Thomas SL Wakerman J Humphreys JS Ensuring equity of access to primary health care in rural and remote Australia—what core services should be locally available?.Int J Equity Health. 2015; 14: 111Crossref PubMed Scopus (95) Google Scholar Low health literacy, institutionalised racism, and scarcity of cultural representation within the health-care system make it harder for socioeconomically disadvantaged populations, including First Nations Peoples, to access mainstream health-care services. Australian Federal and State Health Authorities must refrain from exclusively relying on state-level and national-level data to determine health priorities and allocate funds accordingly. It is also imperative to generate evidence and develop programmes to address the specific needs of rural communities. We declare no competing interests.